Rollout of online medical consultations easier said than done

The Yomiuri Shimbun
Sou Ishii, right, head of the Kudanshita Ekimae Coco Clinic in Chiyoda Ward, Tokyo, speaks to a patient online.

The government plans to make online medical services a central part of efforts to ease the looming pressure on fever outpatient services amid the threat of a simultaneous outbreak of COVID-19 and seasonal flu.

However, in addition to the fact that relatively few medical facilities are equipped to provide online services, many medical workers have expressed concerns about whether influenza can be properly diagnosed online and whether medication can be swiftly delivered to patients.

“It’s difficult to accurately diagnose influenza through an online consultation,” said Sou Ishii, head of the Kudanshita Ekimae Coco Clinic in Chiyoda Ward, Tokyo.

Young fever patients and others at low risk of becoming seriously ill will be asked to self-administer coronavirus tests at home under the government’s plan for dealing with a simultaneous outbreak.

Patients who test negative will have the option of receiving an online consultation or visiting their family doctor for an in-person consultation.

This will free-up capacity to treat elderly people, those with underlying medical conditions and others at high risk of becoming seriously ill at the about 41,000 fever outpatient facilities across Japan.

Normally, patients with flu symptoms such as a sore throat would see a doctor face-to-face and a diagnosis would be made based on a test of a mucus sample taken from the patient’s nose.

Since the start of November, Coco Clinic has been conducting more remote consultations for fever patients, but Ishii said, “It’s hard to gauge a patient’s overall condition [online], and I can’t get as much information about their health … I’m taking particular care to ensure I don’t miss signs that a patient might be at risk of becoming even more unwell.”

Dual flu-COVID test

The Health, Labor and Welfare Ministry is considering expanding the use of kits that can simultaneously test for coronavirus and influenza. Currently, such kits can only be used at medical facilities. An expert panel will discuss the issue on Monday.

Dual test kits must be used within a certain time of a fever developing, so there are concerns over their accuracy.

However, if the test kits were sold online or at pharmacies, the number of people visiting fever outpatient clinics to get tested would decline. The results of home tests would also be helpful for a doctor during an online consultation.

Time is of the essence

Efforts to expand and boost diagnosis and treatment procedures are also being hastened.

At present, about 17,000 medical facilities across Japan are capable of providing online consultations. This is less than 20% of all medical facilities in the nation. Moreover, these facilities include a wide range of medical departments, so the number that can provide services for influenza patients is even lower.

Prime Minister Fumio Kishida has called for the expansion of online consultations and other services, but in reality these are not widely offered.

Some local governments have started taking it upon themselves to bolster medical services. The Kanagawa prefectural government is preparing a system under which 6,000-9,000 online consultation slots per day will be available should fever outpatient clinics be unable to cope with a surge in patients.

Concerns also have been raised over whether anti-influenza drugs can be swiftly sent to patients, as the medication is unlikely to have a substantial effect if taken more than 48 hours after symptoms develop.

“Doing a test at home and then making an appointment for an online consultation and other steps all takes time,” a doctor said. “It’s highly likely patients won’t be able to receive the medication and take it in time.”

According to the Tokyo Pharmaceutical Association, a growing number of drug stores deliver medication to patients. However, in the event of a major outbreak, small pharmacies could become inundated with orders.

“Large pharmacies in each region have to take a central role in a framework to realize medication deliveries,” said an official of the association.

Xocova, an oral medicine for COVID-19 developed by Shionogi & Co., Ltd., could be available from early December for use even by young people without underlying conditions.

However, it cannot be taken in combination with some other medicines, which could present a challenge regarding online prescriptions.

Kazunori Oishi, head of the Toyama Prefecture’s health institute, said, “We need to create a safe framework through which medication can be delivered to people who need it.”